Name

Email Address

Address

Phone

*Name Of Church You Are Representing

*Please indicate your role at the meeting: *Please indicate your role at the meeting: Minister of Word & Sacrament Commissioned Pastor (you must be commissioned to a church) Ruling Elder Commissioner Moderator/Chairperson/Designated Representative of a Presbytery Committee or Board Visitor Other I am unable to attend. Please excuse my absence

Please Specify The Type Of Visitor

*Do you have a smart phone/computer/tablet that will allow you to participate in the meeting? *Do you have a smart phone/computer/tablet that will allow you to participate in the meeting? Yes No